CMS EDGE Server Product Manager / Principal / Architect

Huron is a consulting firm that helps healthcare organizations drive growth and enhance performance. They are seeking an experienced CMS EDGE Server Product Manager / Principal / Architect to provide strategic advisory support and expertise in CMS EDGE Server operations and regulatory reporting for healthcare payer clients.

Responsibilities:

• Serve as SME for CMS EDGE Server, ACA Risk Adjustment, and Reinsurance programs
• Lead CMS EDGE Server implementations, enhancements, and operational support initiatives
• Ensure accurate and compliant submission of membership, claims, encounter, and supplemental data to CMS
• Drive data validation, reconciliation, and reporting quality improvements
• Partner with business, operational, compliance, and technical teams to resolve data and reporting issues
• Translate business requirements into product, process, and technical solutions
• Provide strategic advisory support to health plan clients on CMS reporting best practices

Requirements:

• 7+ years of healthcare payer experience
• Deep expertise with CMS EDGE Server and ACA Risk Adjustment
• Strong understanding of Reinsurance, Risk Adjustment, and regulatory reporting requirements
• Experience with health plan membership, claims, and encounter data
• Proven implementation and client-facing consulting experience
• Strong knowledge of payer operations and data quality processes
• Excellent communication and stakeholder management skills
• Experience with Facets (TriZetto)
• Medicare and Medicaid experience
• Experience with Cognizant CMS EDGE Server and ClaimSphere
• Knowledge of HEDIS, CMS STARs, and quality reporting programs
• SQL, analytics, or healthcare data management experience